anasethesia.Cardiac arrest.(dr.amer)

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anasethesia.Cardiac arrest.(dr.amer)

  1. 1. Cardiac arrest and cardiopulmonary resuscitation ((CPRBLS: basic life supportACLS: advanced cardiovascularlife support
  2. 2. How CPR Works• Effective CPR provides 1/4 to 1/3 normal blood flow• Rescue breaths contain 16% oxygen (21%)
  3. 3. Start CPR Immediately• Better chance of survival• Brain damage starts in 4-6 minutes• Brain damage is certain after 10 minutes without CPR
  4. 4. Do Not Move the Victim Until CPR is Given and Qualified Help Arrives• threat of fire or explosion• victim must be on a hard surface• Place victim level or head slightly lower than body
  5. 5. Survey The Scene, then: RAP• R - Responsiveness Tap shoulder and shout “Are you ok?”• A - Activate EMS ( if unresponsive) Call 122 or call for help• P - Position on back All body parts rolled over at the same time Always be aware of head and spinal cord injuries
  6. 6. BLSA: AirwayB: BreathingC: Circulation
  7. 7. BLSGoal: to support oxygenation,ventilation, and circulation untilROSC (return of spontaneouscirculation( or ACLS interventionscan be initiatedIt does not include advancedinterventions e.g ET tube or drugadministration
  8. 8. Checking Vital Signs• A – Airway Open the airway Head tilt chin lift (For all victims unless cervical spine injury is suspected)
  9. 9. Opening the Airway• Without head extension where cervical spine injury is suspected.• jaw thrust
  10. 10. B – Check For BreathingLook, listen and feel for breathingNo longer than 10 seconds
  11. 11. BreathingIf the victim is not breathing, give two breaths (1 second or longer(  Pinch the nose  Seal the mouth with yours
  12. 12. Breathing: Mouth To Nose (when to use) • Can’t open mouth • Can’t make a good seal • Severely injured mouth • Stomach distension• Mouth to stoma (tracheotomy)
  13. 13. C - CompressionsLocate proper hand position for chest compressions  Place heel of one hand on center of chest between the nipples
  14. 14. Compressions– Using both hands, give 30 chest compressions • Count 1, 2, 3 …– Depth of compressions: 1 .5 to 2 inches– For children: ½ to 1/3 of chest depth and use 1 or 2 hands
  15. 15. Hand Placement• Use the mid-nipple line for adults and children• Rock the heel of the hand off the chest, keeping fingertips on chest wall to maintain hand position.
  16. 16. Cardiac Pump Component• Blood flow during CPR is due to the direct compression of the heart between the sternum and the spine
  17. 17. Thoracic Pump) Component)• During chest compression, increased pressure in the chest, aided by one-way valves in the heart and veins, causes forward movement of blood through the circulatory system.
  18. 18. Decompression Phase• The ribs and sternum act as a bellows.• As the chest expands, a vacuum is created.• Blood returns to the heart during this relaxation• This small, but important, vacuum (negative pressure)  draws blood back into the chest toward the heart  Increases blood flow into the chambers of the heart
  19. 19. Decompression Phase, contd• The more blood that returns to the heart (preload), the more that is circulated forward (cardiac output) with the next chest compression. – increases blood flow to the brain – increases blood flow through the arteries of the heart
  20. 20. Quality of CHEST COMPRESION EMPHYSIS ON1. Push hard and push fast adequate depth rate of 100 compression per minute2. Allow full chest recoil equal compression and relaxation3. Minimal interrupted chest compression
  21. 21. CPR• After 30 chest compressions give:• 2 slow breaths• Continue until help arrives or victim recovers• If the victim starts moving: check breathing
  22. 22. ?When Can I Stop CPR• Victim revives• Trained help arrives• Too exhausted to continue• Unsafe scene• Physician directed (do not resuscitate orders(• Cardiac arrest of longer than 30 minutes – (controversial(
  23. 23. Why CPR May Fail• Delay in starting• Improper procedures (ex. Forget to pinch nose)• No ACLS follow-up and delay in defibrillation Only 15% who receive CPR live to go home Improper techniques• Terminal disease or unmanageable disease (massive heart attack)
  24. 24. Injuries Related to CPR• Rib fractures• Laceration related to the tip of the sternum Liver, lung, spleen
  25. 25. Complications of CPR• Vomiting Aspiration Place victim on left side Wipe vomit from mouth with fingers wrapped in a cloth Reposition and resume CPR
  26. 26. ACLSA: AirwayB: BreathingC: CirculationD: Defibrillator
  27. 27. • Good ACLS begin with good basic life support• High quality properly performed CPR will save lives• ACLS is designed to minimize interruption with chest compression• ACLS includes defibrillation, oxygen, drug therapy
  28. 28. Rescue Breathing During CPR with an Advanced Airway• Airway secured (ET tube)• Ventilations at 8-10 times per minute, or approximately every 6-8 seconds• Do not pause for breaths
  29. 29. Mouth to Mouth Barrier Devices
  30. 30. Two-Person Rescue Breathing with a BVM• Maintain a tight, two- handed facemask seal.• When it’s time to pause compressions to give breaths, the person doing chest compressions should reach over and squeeze the ventilation bag.
  31. 31. AED & DefibrillationCardiac arrest not witnessed by EMS:• Perform 5 cycles or 2 minutes of CPR before analyzing rhythmEMS-witnessed Arrest:• Use AED first in adult victims when AED is immediately available
  32. 32. • Each cycle of CPR consist of: 2 ventilation to 30 compression 5 cycles in 2minutes• Change provider in delivering compression every 5 cycles to avoid fatigue• Defibrillation: for greatest success deliver shock 5 sec. or less after last compression• no rhythm checks for two minutes following shock delivery
  33. 33. • Failure of first shock =resume the CPR defibrillator first shock= 90% successful• CPR helps heart pump blood when post shock systole or PAE is likely to be present• Manual defibrillation energy dose manual monophasic = 360 j for adult manual biphasic = 150-200j the second dose should be the same or higher dose
  34. 34. CPR for Infants ((Under 1 Year of Age• Same procedures (RAPAB) except:• Seal nose and mouth or nose only• Give shallow “puffs”
  35. 35. • Give CPR Press sternum 1/2 to 1/3 depth of the chest Use middle and ring finger30 compressions to 2If alone, resuscitate for 2 minutes then call 122

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